摘要：Objectives. We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races. Methods. We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009. Results. AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (−25.8%/year) and remained stable thereafter. Conclusions. Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions. Cervical cancer is the third most common cancer for women, and the fourth most common cause of cancer deaths globally. 1 In the United States, cervical cancer is less common because of availability of screening and follow-up treatment, with about 12 000 cases diagnosed and 4000 deaths from the disease annually. 2 Cervical cancer screening has resulted in well-documented declines in cervical cancer incidence and mortality, but women who do not receive recommended screening and follow-up are at increased risk for cervical cancer mortality. 3 Previous studies have shown higher cervical cancer incidence and mortality among American Indian/Alaska Native (AI/AN) populations, compared with White populations. 4–8 Because most cases of invasive cervical cancer are preventable through screening and follow-up, disparities in measures of cervical cancer among AI/AN women are generally attributed to decreased access and additional barriers (such as increased distance to get treatment or cultural differences). 3 Programs addressing cervical cancer disparities by increasing screening among AI/AN populations have had positive results, although ongoing regional disparities have been documented. 5,9 Observed disparities in incidence rates of cervical cancer between AI/AN and White populations increased after efforts were made to ensure that members of AI/AN populations were properly identified, which increased the number of AI/AN cases and corresponding rates. 5 We described the mortality and incidence of cervical cancer among AI/AN women from 1999 to 2009, using techniques to minimize the effect of race misclassification in surveillance data, and to compare rates of cervical cancer among these women to rates among other women living in the same geographic region. Trends for mortality from 1990 to 2009 were also presented.
